SMART START: An option for adolescents to delay the pelvic examination and blood work in family planning clinics

Abstract

Purpose: The goal was to encourage earlier use of family planning services and effective birth control for teens. Method: In three federally-funded family planning clinics, the SMART START service model was offered to non-pregnant teens under 18. Teens making their first family planning visit to the clinics for family planning services had the option to delay the requisite pelvic examination and blood work following a careful medical and social history for up to 6 months while obtaining oral contraceptives and/or other non-prescriptive contraceptives. Each teen also received individualized counseling and follow-up telephone contacts. Survey and medical chart data were collected during the project period to evaluate the effects of SMART START on 151 teens. Results: Of the 151 teens, 26% delayed the pelvic examination and 40% delayed the blood work. The delay of medical services did not result in negative health outcomes. Teens who elected to delay the pelvic examination returned to the clinic as frequently for revisits, they reported using condoms more consistently, they had fewer pregnancies and had similar STD rates compared with those not delaying. SMART START also found that ethnic factors correlated with deferring the blood work. Conclusions: SMART START offered teens options over how and when they receive reproductive health care services without withholding effective contraceptive methods. No serious complications of STDs resulted from the delay procedures. Expansion of the SMART START model to include both teen and adult populations is encouraged.